"St. Francis said a long time ago that you start out
doing what's necessary, then you do what's possible, and someday you're doing
the impossible." O'Neill is considered the architect of the President's
Emergency Plan for AIDS Relief (PEPFAR), the Bush-era initiative that is
responsible for saving millions of lives around the world, particularly in Africa.
He was addressing Catholic Relief Services' forum on continuum of care for
people with HIV, held in Washington, D.C., over two days in September.

"If you think back to where we were 10 years ago,"
O'Neill said of the days before PEPFAR when AIDS was ravaging Africa, when a
diagnosis of HIV was considered a death sentence, "what we
are doing is the impossible."

Indeed, a decade ago, the idea that so many people in Africa
would be alive and living normal lives even while HIV-positive seemed beyond impossible.
But that is what PEPFAR funding, in the hands of agencies like CRS, has
accomplished.

Continuum of Care

The forum, which attracted nearly 200 people, showed that
doing this impossible work is not just a matter of handing out the lifesaving
antiretroviral pills that PEPFAR provides and expecting patients to take them.
That approach doesn't work anywhere and is especially ineffective in the
developing world where patients might be desperately poor. They barely find
enough to eat to stay alive. Gathering the extra food necessary to make their antiretroviral
drugs safe and effective is often impossible. Some with HIV are crowded in
horrific urban slums; others are spread out over a hardscrabble countryside.
For many, access to health care services can be limited at best.

CRS is part of AIDSRelief, a consortium of five institutions
that administers a $500-million PEPFAR grant in 10 countries, eight of them in
Africa. Using the knowledge of health care practitioners, the experience of
dedicated aid workers and the reach of the Catholic Church, AIDSRelief has a
very high percentage of HIV-positive patients who stay on their antiretroviral
treatment regimen and survive once they are on the medication—more than 90
percent. In fact, the percentage is higher than for similar programs in some
U.S. cities.

Focus on the Whole Person

The forum documented AIDSRelief's work in a series of panels
that showed how basing care in communities, paying attention to details, and
keeping the focus on the whole person—not just this deadly virus—can lead to
tremendous success.

Christina Kateyaka and Danny Lundu are both living with HIV and attended the CRS HIV Continuum of Care Forum in Washington, D.C., in September 2009. Photo by Jim Stipe/CRS

In his welcoming remarks, CRS President Ken Hackett said
that Catholic social teaching informs all of CRS' work in the HIV area and is
fundamental to its success.

"We look at the economic, the social, the physical, the
cultural, the psychological and the spiritual dimensions of people, and we plan
our interventions with this complex reality in mind," Hackett said.

The respect for CRS' work in the HIV arena was evident from
those who came to speak. O'Neill was preceded by Dr. Robert Gallo, the
co-discoverer of HIV whose work provided the first results that showed that HIV
was the cause of AIDS. As director of the Institute of Human Virology at the
University of Maryland School of Medicine—one of CRS' partners in AIDSRelief—Gallo
continues to lead some of the most cutting-edge research in the field.

Gallo called the PEPFAR-funded work that CRS, AIDSRelief
partners and others are doing, "as noble and successful and historical a
program that I know of in the history of medicine."

'Voice to the Voiceless'

On the second day, welcoming remarks were given by Dr. Eric
Goosby, who as the U.S. global AIDS coordinator is essentially in charge of the
PEPFAR program that last year was renewed for another five years and $48
billion. Goosby called for using the PEPFAR model and funding to go beyond HIV
and AIDS treatment and build the ability of governments around the world to
take care of their own health care needs.

Later that day, a panel highlighted CRS' successes in
turning over control of our HIV programs to local partners.

"We should be doing all we can to make these projects
sustainable in local hands," said Ruth Stark, CRS' country representative in
South Africa. Stark had just overseen the handoff of the $50-million AIDSRelief
effort to the local partner, the Southern African Catholic Bishops' Conference.
South Africa is the first of the 10 AIDSRelief programs to make that
transition.

At the end of the forum, Michel Sidibé, executive director
of the Joint United Nations Program on HIV/AIDS (UNAIDS), greeted
participants at a closing reception. "You reach the unreachable," he
said of CRS' work on HIV. "You give voice to the voiceless."

Three beneficiaries of CRS' work in Africa, all living with
HIV, spoke at the forum. Christine Kateyaka and Danny Lundu told of their meeting
at an HIV counseling program in Zambia, getting on treatment and eventually
getting married. Their daughter, nearly 2 years old, has tested negative for
HIV. Tich, a 19-year-old from Zimbabwe, told of surviving his diagnosis and
going on to use his art to speak of his determination to lead a full and vital
life.

Equal Access to Good Health Care

In other welcoming remarks on the second day, Dr. Robert R.
Redfield, who cofounded the Institute of Human Virology with Gallo,
emphasized how the work of AIDSRelief reflects Catholic social teaching's call
for "health equity"—the ability of all people of the world to access
good health care on an equal basis.

Redfield said that it is only faith-based organizations like
CRS—which has its foundation in the Catholic Church—that can make the
commitment to reaching health equity because doing that requires the type of
long-term view and long-term commitment that comes from faith.

Tich told of surviving his diagnosis and going on to use his art to speak of his determination to lead a full and vital life. Photo by Jim Stipe/CRS

"Today, most people don't believe that health equity is
an obtainable goal," he said. "You need organizations committed to
it, who see it at the end of the tunnel, even if that's 200 years from now."

Redfield said this would be a long struggle. "I believe
we need very effective partnerships of governments, faith-based organizations
and academic institutions if we are going to move toward the goal of health
equity," he said.

"We will not see it in my lifetime, or in my
grandchildren's lifetime," Redfield said. "But we do see it now in
the sacred faces before us, in one life at a time."

Commitment to the Whole Person

Michele Broemmelsiek, CRS' global director for AIDSRelief,
gave an overview of the consortium's work and said that its strength is due to
its faith-based approach. "This gives us a very strong commitment to the
community, to the whole person, the whole family," she said. "This is
a critical factor in our success."

O'Neill said that in the early days of formulating PEPFAR,
when he was in the Bush White House, he was determined to get faith-based
organizations involved, not because he wanted to push any faith—which he noted
would be improper for a government official—but because he wanted results.
During a visit to Zambia, he had seen the commitment and effectiveness of a
hospital run by the Salvation Army.

"Using faith-based organizations was the smart way to
get things done," he said, referring with pride to getting AIDSRelief—with
CRS as a major player—fully funded.

'They Said It's Impossible'

It all seemed to go back to that statement by St. Francis
that he quoted at the beginning of the two days, about moving from the
necessary to the possible to the impossible. O'Neill recalled his days working
in a San Francisco-area hospital in the early 1980s when patients with AIDS
first began appearing. Most survived only a few months.

"They said there was nothing you could do for those
people, that it was impossible," he said, then pointed to all the progress
that was made keeping those with HIV alive and healthy.

O'Neill then moved to an inner-city clinic in Baltimore
where most of those with HIV were poor African-Americans. "They said maybe
you can do something with people in San Francisco and Greenwich Village, but it's
impossible with this population," he said. But he got to work and success
followed.

Then the focus moved to the spread of HIV in Africa. "They
said maybe you can do something in developed countries, but it's impossible to
do anything in Africa," O'Neill said.

"Guess what? We did it."

Michael Hill is CRS' communications officer
for sub-Saharan Africa. He is based at the agency's headquarters in Baltimore.